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目的探讨牛肺表面活性剂对行机械通气治疗新生儿呼吸窘迫综合征临床疗效及对患儿血清垂体前叶激素的影响。方法选择450例呼吸窘迫综合征患儿为研究对象,随机分为治疗组和对照组,每组225例,在一般治疗基础上,对照组患儿行机械通气治疗,治疗组在对照组的基础上应用牛肺表面活性剂,按70~100 mg/kg气管内滴入,给药6 h内尽量减少拍背吸痰次数,根据患儿病情如有必要6~12 h可重复给药1次,两组患儿均给予通气治疗24 h。观察两组患儿治疗前、用药后6 h血气分析结果、血清垂体前叶激素和并发症情况。结果两组患儿经治疗后,治疗组二氧化碳分压(PaCO_2)、吸入氧浓度(FiO_2)、呼气末正压(PEEP)水平显著降低,pH、氧分压(PaO_2)水平显著升高,改善程度均显著高于对照组(P<0.05);治疗后两组促肾上腺皮质激素(ACTH)和促甲状腺激素(TSH)含量均降低,治疗组ACTH和TSH降低程度显著高于对照组(P<0.05);治疗组颅内出血(7.56%)、呼吸机相关性肺炎(12.44%)发生率显著低于对照组(χ~2=21.92、29.83,P<0.05),肺出血(8.00%)、气胸(4.89%)发生率与对照组(9.33%、5.78%)比较差异无统计学意义(χ~2=0.25、0.87,P>0.05)。结论牛肺表面活性剂对行机械通气治疗的呼吸窘迫综合征新生儿临床疗效显著,可改善患儿肺通气及氧合功能,减少机械通气并发症产生。
Objective To investigate the clinical efficacy of bovine pulmonary surfactant in the treatment of neonatal respiratory distress syndrome with mechanical ventilation and its effect on serum anterior pituitary hormones in children. Methods A total of 450 children with respiratory distress syndrome were selected as study subjects and randomly divided into treatment group and control group, with 225 cases in each group. On the basis of general treatment, children in control group were treated with mechanical ventilation, and the treatment group was basal in control group On the application of bovine pulmonary surfactant, according to tracheal instillation of 70 ~ 100 mg / kg, within 6 h administration to minimize back sputum suction, depending on the patient’s condition if necessary, 6 ~ 12 h repeatable 1 , Two groups of children were given ventilation for 24 h. The blood gas analysis results, serum anterior pituitary hormones and complications before and after treatment were observed in two groups of children. Results After treatment, the levels of PaCO 2, FiO 2 and PEEP in the two groups were significantly decreased, while the levels of PaO 2 and PaO 2 in the two groups were significantly decreased (P <0.05). The levels of ACTH and TSH decreased in both groups after treatment, and the reduction of ACTH and TSH in the treatment group was significantly higher than that in the control group (P <0.05) 0.05). The incidence of intracranial hemorrhage (7.56%) and ventilator-associated pneumonia (12.44%) in the treatment group was significantly lower than that in the control group (χ ~ 2 = 21.92, 29.83, P < The incidence of pneumothorax (4.89%) was not significantly different from that of the control group (9.33%, 5.78%) (χ ~ 2 = 0.25,0.87, P> 0.05). Conclusion Bovine pulmonary surfactant has significant clinical effect on neonatal respiratory distress syndrome with mechanical ventilation, which can improve pulmonary ventilation and oxygenation and reduce the complications of mechanical ventilation.